Anticoagulation in simultaneous pancreas kidney transplantation - On what basis?  

作　　者：Jeevan Prakash Gopal Frank JMF Dor Jeremy S Crane Paul E Herbert Vassilios E Papalois Anand SR Muthusamy 

机构地区：[1]Imperial College Renal and Transplant Center,Imperial College Healthcare NHS Trust,Hammersmith Hospital,London W120HS,United Kingdom [2]Department of Surgery and Cancer,Imperial College,London W120HS,United Kingdom

出　　处：《World Journal of Transplantation》2020年第7期206-214,共9页世界移植杂志

摘　　要：BACKGROUND Despite technical refinements,early pancreas graft loss due to thrombosis continues to occur.Conventional coagulation tests(CCT)do not detect hypercoagulability and hence the hypercoagulable state due to diabetes is left untreated.Thromboelastogram(TEG)is an in-vitro diagnostic test which is used in liver transplantation,and in various intensive care settings to guide anticoagulation.TEG is better than CCT because it is dynamic and provides a global hemostatic profile including fibrinolysis.AIM To compare the outcomes between TEG and CCT(prothrombin time,activated partial thromboplastin time and international normalized ratio)directed anticoagulation in simultaneous pancreas and kidney(SPK)transplant recipients.METHODS A single center retrospective analysis comparing the outcomes between TEG and CCT-directed anticoagulation in SPK recipients,who were matched for donor age and graft type(donors after brainstem death and donors after circulatory death).Anticoagulation consisted of intravenous(IV)heparin titrated up to a maximum of 500 IU/h based on CCT in conjunction with various clinical parameters or directed by TEG results.Graft loss due to thrombosis,anticoagulation related bleeding,radiological incidence of partial thrombi in the pancreas graft,thrombus resolution rate after anticoagulation dose escalation,length of the hospital stays and,1-year pancreas and kidney graft survival between the two groups were compared.RESULTS Seventeen patients who received TEG-directed anticoagulation were compared against 51 contemporaneous SPK recipients(ratio of 1:3)who were anticoagulated based on CCT.No graft losses occurred in the TEG group,whereas 11 grafts(7 pancreases and 4 kidneys)were lost due to thrombosis in the CCT group(P=0.06,Fisher’s exact test).The overall incidence of anticoagulation related bleeding(hematoma/gastrointestinal bleeding/hematuria/nose bleeding/re-exploration for bleeding/post-operative blood transfusion)was 17.65%in the TEG group and 45.10%in the CCT group(P=0.05,Fisher’s exact t

关 键 词：ANTICOAGULATION Pancreas transplantation THROMBOELASTOGRAPHY THROMBOSIS HYPERCOAGULABILITY 

分 类 号：R73[医药卫生—肿瘤]